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A study by researchers (Miller, Chu, Gollan and Gossett) at the Northwestern University in Chicago (US) have reported that that 11% of women who have recently given birth have a much higher rate of OCD symptoms compared with 2% to 3% of the general population.
The incidence rate is almost the same as that for post-natal depression, which affects around one in 10 new mothers.
The symptoms, which include fear of hurting the baby and worrying about germs, are usually temporary, according to the researchers. Researchers speculate the obsessiveness could result from hormonal changes or manifest as an adaptive response to caring for a new baby. But if the obsessive compulsions interfere with a new mother’s functioning, they may indicate a psychological disorder, the researchers warn.
“It may be that certain kinds of obsessions and compulsions are adaptive and appropriate for a new parent, for example those about cleanliness and hygiene,” said senior author Dr Dana Gossett, “But when it interferes with normal day-to-day functioning and appropriate care for the baby and parent, it becomes maladaptive and pathologic.”
The researchers noted that their own obsessive and upsetting thoughts after giving birth led them to investigate if the experience was universal. For postnatal women with OCD type symptoms who otherwise are functioning normally, “it would be reassuring to hear that their thoughts and behaviours are very common and should pass,” Gossett said.
The women in the study reported that their most prevalent thoughts were about dirt or germs, followed by compulsions to check that they did not 'make a mistake' Dr Emily Miller lead author said. For example, new mothers may check and recheck baby monitors are working, the baby’s crib side is properly latched or bottles are properly sterilised. Some women reported intrusive thoughts that they would harm the baby, according to the researchers. “That can be emotionally painful” Miller said. “You don’t intend to harm the baby, but you’re fearful that you will.”
Gossett recalled that after she gave birth to her first child, she routinely worried about falling down the stairs with her baby or that the baby would fall out of bed. “It comes into your mind unbidden and it’s frightening” she said.
This fear is not uncommon as Rachel shared her story for OCD-UK during OCD Awareness Week last October, but as Rachel's story highlights, in her case she already had OCD, so pregnancy was more of a trigger.
The women in the study were recruited while hospitalised after delivering their babies at Northwestern Memorial Hospital. They completed screening tests for anxiety, Depression and OCD two weeks and six months after going home. According to the researchers, 461 women completed the surveys at two weeks and 329 completed them at six months.
In about half the cases investigated, OCD type problems began to improve after about six months. However, some women only begin to display symptoms this long after delivery and the risk remains for up to a year after giving birth the researchers reported. “If those symptoms are developing much later after delivery, they are less likely to be hormonal or adaptive” Gossett said.
About 70 percent of the women who screened positive for OCD type symptoms also screened positive for depression. That overlap and the subset of obsessions and compulsions could indicate that postnatal OCD represents a distinct postnatal mental illness that is not well classified, according to Miller. “There is some debate as to whether postpartum depression is simply a major depressive episode that happens after birth or its own disease with its own features” she said. “Our study supports the idea that it may be its own disease with more of the anxiety and obsessive-compulsive symptoms than would be typical for a major depressive episode.”
The researchers concluded that the postnatal period is a high-risk time for the development of OCD symptoms. When such symptoms develop, they have a high likelihood of persisting for at least 6 months. However, it needs to be emphasised that none of these women actually received a clinical diagnoses of OCD, and only Obsessive Compulsive tendencies were self-reported the researchers note. It is also possible that like Rachel, that OCD was already present in some of these women, with the added stress of pregnancy being more of a trigger for further OCD problems, than a cause.
You can read more about postnatal OCD on our website here.